[Histological, etio-pathological and clinical characteristics of epithelial carcinoma of the ovary: analysis of 115 cases].
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Biomedical subjects
Publications and source records attributed to S Franceschi.
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A history of benign thyroid diseases has been associated with the risk of thyroid cancer. We have analyzed this issue using data from a case-control study conducted in northern Italy between 1986 and 1992 on 399 incident, histologically confirmed thyroid cancer cases and 617 controls admitted to the hospital for acute, nonneoplastic, non-hormone-related diseases. The overall multivariate relative risk (RR) estimates were 2.8 [95% confidence interval (CI), 0.6-12.4] for previous episodes of thyroiditis, 27.1 (95% CI, 6.5-111.9) for adenoma, 8.2 (95% CI, 3.5-19.1) for goiter, 3.8 (95% CI, 1.4-10.9) for hyperthyroidism, and 1.5 (95% CI, 0.4-5.1) for hypothyroidism when all histotypes were analyzed. The RR for any thyroid disease was 7.7 (95% CI, 4.6-12.8). A family history of thyroid disease was significantly related to thyroid cancer with an RR of 1.6. The RR for having resided in endemic goiter areas was 1.3 for < 20 years of residence and 1.6 for 20 or more years. These associations were somewhat stronger when only papillary, follicular, and mixed papillary/follicular cancers were considered. Analyses of data in separate strata of sex and age suggested that several benign conditions play a more important role in females and in subjects younger than 50 years. Results were similar to the overall ones when papillary and follicular carcinomas were considered separately. The population-attributable risk for any previous thyroid disease was approximately 20% in this Italian population. These results confirm that history of thyroid disease is a relevant indicator of subsequent thyroid cancer risk also in areas at relatively low prevalence of goiter and other thyroid diseases.
All ages and truncated (35 to 64 years) mortality rates from all neoplasms and from cancers of the lung, stomach, intestines, and breast for the six calendar quinquennia from 1960-1964 to 1985-1989 were computed from official death certification data and population estimates obtained from the World Health Organization database for total Europe (excluding former Soviet Union) and for three broad European areas: (a) member countries of the European Economic Community for the last period of the study; (b) other Western European countries; and (c) Eastern European countries. In Europe, mortality rates for all neoplasms increased for men and decreased for women. The increase in men can be largely explained by the major tobacco-related lung cancer epidemic throughout Europe. Lung cancer mortality rates rose steeply in Eastern Europe, where the truncated rates reached the highest levels ever observed, and there is no evidence of a leveling off. Stomach cancer mortality decreased in all Europe for both sexes, although rates remained higher in Eastern Europe, while intestinal cancer rates tended to level off around the highest values in various areas of the continent. Breast cancer showed a moderate but steady increase. Overall, the most unfavorable trends were in Eastern Europe, due to major epidemics in tobacco-related neoplasms and in other common cancers related to diet and other lifestyle habits.
Information on the etiology of esophageal cancer in lifelong nonsmokers is of interest to understand and quantify risk factors for the disease in the absence of the residual confounding by tobacco. Of a total of 316 cases with histologically confirmed incident cancers of the esophagus, 46 (17 males and 29 females) who described themselves as lifelong nonsmokers were selected to assess esophageal cancer risk in the absence of potential confounding and interactive effects of smoking. These patients were compared to 230 lifelong nonsmoker controls (85 males and 145 females) admitted to hospital for acute, nonneoplastic, non-alcohol-related conditions. The major risk factor for cancer of the esophagus in lifelong nonsmokers was elevated alcohol consumption: compared to drinkers of fewer than 4 drinks per day the relative risk (RR) was 2.7 (95% confidence interval, 1.1-6.8) for 4 to fewer than 8 drinks, and 5.4 (95% confidence interval, 1.4-21.0) for 8 or more drinks, with a significant trend in risk. Among selected indicator foods considered, significant protective effects were observed for fish (RR = 0.5 for the highest consumption tertile), green vegetables (RR = 0.6), and fresh fruit intake (RR = 0.3). Consequently, there was a significant inverse relationship with an estimate of beta-carotene intake (RR = 0.5 and 0.4, respectively, for the middle and highest tertiles of intake versus the lowest), with a significant trend in risk. The estimated RR for the highest alcohol consumption and lowest beta-carotene intake category was 8.6, and these two factors together explained over 45% of cases. Gastrectomy and family history of cancer of the esophagus were also associated with increased risk (RR = 4.6 and 4.3, respectively).
The relationship between intake of selected micronutrients and gastric cancer risk was investigated using data from a case-control study conducted in Italy between 1985 and 1992 on 723 cases of histologically confirmed, incident gastric cancer, and 2024 controls hospitalized for acute, nonneoplastic, nondigestive tract diseases. Relative risks of subsequent quintiles of intake were computed after allowance for sex, age, and other major identified potential confounding factors, including an estimate of total calorie intake. No trend in risk emerged for intake of retinol, vitamin D and vitamin E, whereas a protective pattern was observed for consumption of beta-carotene, ascorbic acid, folate, and nitrates, with risk estimates for the highest intake quintiles of 0.27, 0.40, 0.58, and 0.43, respectively. Significant direct trends in risk were found for methionine, calcium, and nitrites. When the effect of various micronutrients was taken into account, a residual protective effect was observed for beta-carotene and ascorbic acid, and a direct association with methionine remained, whereas the protective effect of folates and nitrates and the direct associations of nitrites were no longer evident. The risk estimates for the upper quintiles of beta-carotene, ascorbic acid, and methionine consumption were respectively 0.38, 0.53, and 2.40, and all the trends in risk were significant and consistent across strata of sex and age. Whether this reflects a specific effect of these micronutrients, rather than problems of collinearity or other limitations of the data, is open for discussion. Nonetheless, these data indicate that selected micronutrients may have an impact in the process of gastric carcinogenesis.
The relationship between family history of selected neoplasms in first-degree relatives and the risk of pancreatic, liver, and gallbladder cancer was investigated using data from a case-control study conducted in northern Italy on 320 histologically confirmed incident cases of liver cancer, 58 of gallbladder cancer, 362 of pancreatic cancer, and 1408 controls admitted to the hospital for acute, nonneoplastic, nondigestive tract disorders. Significant associations were observed between family history of hepatocellular carcinoma and primary liver cancer [relative risk (RR) = 2.4; 95% confidence interval (CI), 1.3 to 4.4], between family history of pancreatic cancer and pancreatic cancer (RR = 3.0; 95% CI, 1.4 to 6.6), and between family history of gallbladder cancer and gallbladder cancer (RR = 13.9; 95% CI, 1.2 to 163.9). The elevated risk of liver cancer associated with family history was not materially modified by adjustment for tobacco, alcohol, and personal history of cirrhosis and hepatitis (RR = 2.9; 95% CI, 1.5 to 5.3). Similarly, the risk for pancreatic cancer did not appreciably change after allowance for tobacco, alcohol, dietary factors, and medical history of diabetes and pancreatitis (RR = 2.8; 95% CI, 1.3 to 6.3). This pattern of risk would support the existence of a genetic component in the familial aggregation of liver and pancreatic cancer. In terms of population attributable risk, approximately 3% of the newly diagnosed liver and pancreatic cancers would be related to this familial component.
A unified analysis of the combined effects of alcohol and smoking in cancers of the upper aerodigestive tract was conducted using polychotomous logistic regression to determine if, at the same level of exposure, risk varies significantly across pathological sites. Data from a case-control study in northern Italy include males with tumors of the oral cavity/pharynx, larynx, and esophagus and males admitted to the hospital for acute illnesses not related to alcohol and smoking. The combined alcohol and smoking risks for oral cavity/pharynx cancer in these data were significantly greater than those for either laryngeal or esophageal cancer, but esophageal cancer and laryngeal cancer could not be distinguished based on risk. The differences may lie in the presence of unspecified factors in the oral cavity and pharynx, but not in the other upper aerodigestive tract sites, which potentiate the effects of alcohol and smoking in the oral cavity/pharynx.
Using data from a case-control study conducted between 1984 and 1992 in the provinces of Milan and Pordenone, northern Italy, on 439 cases of oral and pharyngeal cancers and 2106 hospital controls, we computed the population attributable risk for oropharyngeal cancer in relation to tobacco, alcohol, and a measure of low beta-carotene intake. Two different models were used for estimating relative risks, one assuming that the three factors act multiplicatively on the relative risk and the second estimating separately each combination of alcohol and tobacco and assuming a multiplicative model only for beta-carotene. The estimated attributable risks were similar for the two models considered. For both models and both sexes, the single factor with the highest attributable risk was smoking, which accounted for 81-87% of oral cancers in males and for 42-47% in females. Alcohol explained about 60% of male cases, but only 15% of female ones, and low beta-carotene accounted for 24% of total cases (25% of males, 17% of females). Together the three factors were responsible for 91-94% of oropharyngeal cancers in males, 51-57% in females, and 85-88% in both sexes combined. The present knowledge of major identified risk factors could, in principle, reduce the burden of the disease in Italy from 2400 to about 200 deaths per year for males and from 500 to 230 for females, thus explaining the difference in incidence and mortality between the two sexes.
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We tested the hypothesis of a relationship between Kaposi's sarcoma (KS) and volcanic soil by means of a case-control study based on 70 cases of classic KS and 280 hospital controls from the Campania region, an area of active volcanism in the South of Italy. Birth and residence in volcanic areas were associated with approximately two-fold elevated KS risks. If not due to chance, increased risk in the presence of volcanic soil can have different interpretations, including local immune impairment and correlation with unknown environmental or genetic KS predisposing factors.
The incidence of liver cancer appears lower in Europe and the USA and it is often looked upon as a problem in developing countries. Liver cancer has two main risk factors: the abuse of alcohol and the elevated prevalence of hepatitis B and C viruses. In Italy the first one is mainly present in the North and the second one in Southern less developed areas. Our study evaluates the relationship between living in urban and suburban zones in South of Italy in conditions of overcrowding, poor health services and high incidence of hepatitis and liver cancer.
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Direct association between obesity and total mortality, has been already established for some cancers especially in women. Data from a large case-control study (2,569 cases and 2,588 controls) carried out in 1991-94 in six Italian areas, were used to estimate postmenopausal breast cancer risk, according to body mass index (BMI) and age. Risk seemed to increase from the sixth (odds ratio for BMI > or = 30.0 vs. BMI < 21.7 = 1.0) to the eighth decade (odds ratio = 2.7) of life. Percentages of obesity in Italy by age and geographical area are shown (ISTAT data--Household Multipurpose Survey 1990-91). Percentages of obese women were slightly higher in the South with respect to other Italian areas. Percentage attributable risks according to obesity, by geographical area for women aged 65 years or over, were computed. For South Italy and the Islands, this risk was 8.3 whereas it was 6.7 for Italy. Increased physical activity and reduction of total energy intake may be two preventive measures, especially in the South of Italy and the Islands, against diseases related to obesity.